Effects of cancer screening restart strategies after COVID-19 disruption

Br J Cancer. 2021 Apr;124(9):1516-1523. doi: 10.1038/s41416-021-01261-9. Epub 2021 Mar 15.


Background: Many breast, cervical, and colorectal cancer screening programmes were disrupted due to the COVID-19 pandemic. This study aimed to estimate the effects of five restart strategies after the disruption on required screening capacity and cancer burden.

Methods: Microsimulation models simulated five restart strategies for breast, cervical, and colorectal cancer screening. The models estimated required screening capacity, cancer incidence, and cancer-specific mortality after a disruption of 6 months. The restart strategies varied in whether screens were caught up or not and, if so, immediately or delayed, and whether the upper age limit was increased.

Results: The disruption in screening programmes without catch-up of missed screens led to an increase of 2.0, 0.3, and 2.5 cancer deaths per 100 000 individuals in 10 years in breast, cervical, and colorectal cancer, respectively. Immediately catching-up missed screens minimised the impact of the disruption but required a surge in screening capacity. Delaying screening, but still offering all screening rounds gave the best balance between required capacity, incidence, and mortality.

Conclusions: Strategies with the smallest loss in health effects were also the most burdensome for the screening organisations. Which strategy is preferred depends on the organisation and available capacity in a country.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / complications
  • Breast Neoplasms / diagnosis*
  • COVID-19 / complications
  • COVID-19 / epidemiology*
  • COVID-19 / virology
  • Colorectal Neoplasms / complications
  • Colorectal Neoplasms / diagnosis*
  • Early Detection of Cancer*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pandemics*
  • SARS-CoV-2 / isolation & purification
  • Uterine Cervical Neoplasms / complications
  • Uterine Cervical Neoplasms / diagnosis*